{"id":64462,"date":"2022-06-17T08:54:47","date_gmt":"2022-06-17T14:54:47","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=64462"},"modified":"2023-05-02T09:26:31","modified_gmt":"2023-05-02T15:26:31","slug":"harnessing-artificial-intelligence-to-predict-atrial-fibrillation","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/harnessing-artificial-intelligence-to-predict-atrial-fibrillation\/","title":{"rendered":"Harnessing artificial intelligence to predict atrial fibrillation, heart disease up to a year in advance"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_64582\" aria-describedby=\"caption-attachment-64582\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-64582 size-full\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web.webp\" alt=\"New interpretations of heart waves may help predict atrial fibrillation and other heart diseases up to a year in advance. Photo: Getty Images\" width=\"800\" height=\"533\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web.webp 800w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/22142447\/Getty-heart-disease-web-200x133.webp 200w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><figcaption id=\"caption-attachment-64582\" class=\"wp-caption-text\">New interpretations of heart waves may help predict atrial fibrillation and other heart diseases up to a year in advance. Photo: Getty Images<\/figcaption><\/figure>\n<p>Some mashups of old and new don\u2019t quite work: horse carriages and reusable rocket boosters, say. But combine a 19<sup>th<\/sup>-century medical advance with 21<sup>st<\/sup>-century computing technologies, and one now has the ability to identify patients at high risk of atrial fibrillation up to a year in advance. That breakthrough, clinicians hope, will help prevent <a id=\"\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2405500X18302135\" target=\"_blank\" rel=\"noopener\">thousands of strokes<\/a> that hard-to-diagnose Afib causes each year. It also could spot structural heart diseases earlier, improving outcomes through more timely treatment.<\/p>\n<p>The old technology in question is the electrocardiogram (ECG or EKG), a heart-voltage detector <a id=\"\" href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Einthoven\" target=\"_blank\" rel=\"noopener\">invented<\/a> in 1895 that\u2019s been a low-cost, mainstay cardiac diagnostic pretty much ever since. The modern computing technology at play involves machine-learning algorithms developed by Chicago-based <a id=\"\" href=\"https:\/\/www.tempus.com\/\" target=\"_blank\" rel=\"noopener\">Tempus<\/a> and Pennsylvania-based Geisinger Health. Those algorithms feed into a <a id=\"\" href=\"https:\/\/en.wikipedia.org\/wiki\/Convolutional_neural_network\" target=\"_blank\" rel=\"noopener\">convolutional neural network<\/a> that interprets the waveform \u2013 the shape of an ECG\u2019s many spikes, dips and subtle undulations \u2013 in ways no human ever could.<\/p>\n<p>Tempus\u2019s artificial intelligence (AI) works on the same basic architecture as what YouTube uses to scan image data to identify cat videos, or self-driving cars use to identify objects in the road, explains Noah Zimmerman, Tempus\u2019s vice president for translational science.<\/p>\n<p>\u201cAn EKG is measuring voltage, right? We look at those voltages and treat them almost like image data,\u201d he said<\/p>\n<p>While studies in such journals as <a id=\"\" href=\"https:\/\/www.tempus.com\/resources\/publications\/deep-neural-networks-can-predict-new-onset-atrial-fibrillation-from-the-12-lead-electrocardiogram-and-help-identify-those-at-risk-of-af-related-stroke\/\" target=\"_blank\" rel=\"noopener\"><em>Circulation<\/em><\/a> and <a id=\"\" href=\"https:\/\/www.tempus.com\/resources\/publications\/prediction-of-mortality-from-12-lead-electrocardiogram-voltage-data-using-a-deep-neural-network\/\" target=\"_blank\" rel=\"noopener\"><em>Nature Medicine<\/em><\/a> have shown this old-plus-new approach to work surprisingly well \u2013 to the point that the U.S. Food and Drug Administration is <a id=\"\" href=\"https:\/\/www.tempus.com\/news\/pr\/fda-grants-breakthrough-device-designation-to-tempus-atrial-fibrillation-ecg-analysis-platform-developed-in-collaboration-with-geisinger\/\" target=\"_blank\" rel=\"noopener\">fast-tracking<\/a> the technology \u2013 the AI tool needs more testing. Further, once that training has Tempus\u2019s ECG Analysis Platform ready for prime time, the new diagnostic must be incorporated into health care processes so doctors can make the most of it for their patients. In pursuit of those ends, Tempus is partnering with the <a href=\"https:\/\/www.uchealth.org\/innovation\/team\/dr-richard-zane\/\">UCHealth CARE Innovation Center<\/a>.<\/p>\n<h2>Partnering to predict atrial fibrillation and structural heart diseases<\/h2>\n<p>That partnership is proceeding in three phases, says Emily Hearst, UCHealth\u2019s Tempus projected manager. The first is looking retrospectively at the ECGs of 5,000 UCHealth patients and seeing if Tempus\u2019s ECG Analysis Platform can repeat the sort of results it has delivered before. That <em>Circulation<\/em> study involved feeding the ECG Analysis Platform 12-lead digital ECG traces from 430,000 patients collected from 1984 to 2019. Using historical data allowed Tempus and Pennsylvania-based Geisinger Health to see how the AI system\u2019s Afib predictions tracked with future Afib-related strokes. The system spotted nearly two-thirds of patients with no documented history of Afib (Afib being episodic and often without symptoms, it can go undetected for years) but who later had an Afib-related stroke.<\/p>\n<figure id=\"attachment_64474\" aria-describedby=\"caption-attachment-64474\" style=\"width: 218px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-64474 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084609\/David-Kao.webp\" alt=\"Dr. David Kao\" width=\"218\" height=\"300\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084609\/David-Kao.webp 725w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084609\/David-Kao-218x300.webp 218w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084609\/David-Kao-109x150.webp 109w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084609\/David-Kao-200x276.webp 200w\" sizes=\"auto, (max-width: 218px) 100vw, 218px\" \/><figcaption id=\"caption-attachment-64474\" class=\"wp-caption-text\">UCHealth and University of Colorado cardiologist Dr. David Kao<\/figcaption><\/figure>\n<p>Why would examining a fraction of as many patient ECGs as Tempus already did help prove out \u2013 much less improve \u2013 the platform? <a href=\"https:\/\/www.uchealth.org\/provider\/david-kao-md\/\">Dr. David Kao<\/a>, the University of Colorado School of Medicine and UCHealth cardiologist who is working closely with Tempus, says it&#8217;s about diversity. People are people, but the population makeups of Pennsylvania and Colorado differ. An AI-based system\u2019s intelligence must reflect that.<\/p>\n<p>\u201cOverfitting is a huge problem in machine learning, which means it can perform very well in your initial, however-large dataset, but then it doesn\u2019t work anywhere else,\u201d Kao said.<\/p>\n<p>What\u2019s called an external validation set, one using a different patient population than the initial training set, can both refine the model and lend its creators as well as regulators more confidence in the prospects of its real-world performance, Kao says. In this case, the results, if they\u2019re favorable, will strengthen Tempus\u2019s FDA submission for full approval, Hearst adds.<\/p>\n<h2><strong>Beyond predicting Afib<\/strong><\/h2>\n<p>The second phase of the Tempus-UCHealth partnership is boosting the number of previously recorded patient ECGs fed into the Tempus system to 45,000. The goal will be to validate results from a recent <a id=\"\" href=\"https:\/\/www.ahajournals.org\/doi\/abs\/10.1161\/CIRCULATIONAHA.121.057869\" target=\"_blank\" rel=\"noopener\">study<\/a> that showed the model to be capable of using those same ECG traces to predict structural heart diseases \u2013 a group of conditions that adversely affect the valves, walls, chambers, or muscles of the heart such as aortic stenosis and hypertrophic cardiomyopathy.<\/p>\n<p>The third phase of the partnership will also look at structural heart disease, Hearst says, but prospectively \u2013 that is, feeding the Tempus platform ECG readings of current patients and seeing how well it predicts structural heart disease going forward. Should the results of one these studies pan out, UCHealth and Tempus will work on how to integrate the AI-based results into UCHealth\u2019s \u2013 and, by extension, that of many other health systems \u2013 electronic health record, Hearst adds.<\/p>\n<figure id=\"attachment_64475\" aria-describedby=\"caption-attachment-64475\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-64475 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus.webp\" alt=\"A photo of Noah Zimmerman\" width=\"300\" height=\"294\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus.webp 1021w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus-300x294.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus-768x752.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus-150x147.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2022\/06\/17084655\/Noah-Zimmerman-Tempus-200x196.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-64475\" class=\"wp-caption-text\">Noah Zimmerman, Tempus\u2019s vice president for translational science. Photo courtesy of Noah Zimmerman.<\/figcaption><\/figure>\n<p>Success could save countless lives and could have a particular impact on underserved communities in the United States and entire countries abroad. Kao, who has done medical trips to Zimbabwe, says that country has, in the past, had one or two 3D-ultrasound echocardiogram machines of the sort that cardiologists use to diagnose serious heart problems. It takes specialized training to interpret echocardiograms, and the machines themselves cost tens of thousands of dollars. Combining the outputs of an electrocardiogram machine that costs $500 to $2,000 with AI that can spot patients at high risk for Afib or structural heart diseases could identify those who would gain from preventative treatment. In places where cardiac specialists and higher-end diagnostics are available, ECG-based AI results filter patients such as those most likely to have problems see specialists first, Kao says.<\/p>\n<p>Kao adds that he considers partnerships such as UCHealth\u2019s and Tempus\u2019s as an exemplary innovation model, one which combines the rigor and clinical experience of academic medicine with the expertise and commercial motivation of industry.<\/p>\n<p>\u201cI don\u2019t know that one or the other can do it on their own,\u201d he said. \u201cYou need the strengths of both. It\u2019s hard to find partners that line up, but when you do, it\u2019s like lightning in a bottle. You\u2019ve got to hold onto it.\u201d<\/p>\n<p>The old and the new may not always harmonize, but Tempus, with a big assist from UCHealth, appears to be playing a tune that could help patients until AI is old hat, too.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Some mashups of old and new don\u2019t quite work: horse carriages and reusable rocket boosters, say. But combine a 19th-century medical advance with 21st-century computing technologies, and one now has the ability to identify patients at high risk of atrial fibrillation up to a year in advance. That breakthrough, clinicians hope, will help prevent thousands [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":64473,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[3512,3273,9167],"class_list":["post-64462","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-heart-and-vascular-care-cardiovascular","tag-innovative-medical-technologies","tag-specialized-services"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.7) - 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